How we decide when to immobilize the wrist after stable osteosynthesis of displaced distal radius fracture

PURPOSE OF THE STUDY

 Fractures of the distal radius are frequently associated with injuries of the scapholunate (SL) and lunotriquetral (LT) ligaments. Our study is aimed at revealing their hidden lesions by employing a fast and accessible fluoroscopic identification.

PATIENTS AND METHODS

 We investigated 40 patients who were indicated for plate osteosynthesis of distal radius fracture. After completing the osteosynthesis, the procedure was concluded with a wrist arthrography. The patients with SL and LT interval lesions had their wrists immobilized by a plaster splint while patients with normal findings with an elastic bandage. The patients were followed up for 12 months after the surgery. The functional results were evaluated by Mayo wrist score.

RESULTS

The intra-operative examination identified 62.5 % of patients with lesions of SL and/or LT interval, and 37.5 % of patients were lesion-free. The Mayo wrist scores after 3, 6 and 12 months in patients whose wrists were not immobilized were 72, 86.3, and 86.3, respectively. The latter scores in the group of patients with external immobilization were 54.4, 82, and 84.8, respectively. The difference between the groups was significant three months after the surgery. After six and twelve months, the difference became negligible.

CONCLUSION

 The exclusion of hidden lesions allows earlier rehabilitation, while in patients with signs of lesions, it is appropriate to immobilize the wrist (Tab. 1, Fig. 3, Ref. 31). Text in PDF www.elis.sk Keywords: distal radius fractures, scapholunate ligament, lunotriquetral ligament, fluoroscopic, diagnosis.

The importance of choosing appropriate methods for assessing wild food plant knowledge and use: A case study among the Baka in Cameroon

In tropical rainforests, access to and availability of natural resources are vital for the dietary diversity and food security of forest-dwelling societies. In the Congo Basin, these are challenged by the increasing exploitation of forests for bushmeat, commercial hardwood, mining, and large-scale agriculture. In this context, a balanced approach is needed between the pressures from forest exploitation, non-timber forest product trade and the livelihood and dietary behavior of rural communities. While there is a general positive association between tree cover and dietary diversity, the complex biocultural interactions between tropical forest food resources and the communities they sustain are still understudied. This research focuses on the knowledge and use of wild food plants by the forest-dwelling Baka people in southeast Cameroon. By using two different sets of methods, namely ex-situ interviews and in-situ surveys, we collected ethnographic and ethnobotanical data in two Baka settlements and explored the diversity of wild edible plants known, the frequency of their consumption, and potential conflicts between local diet and commercial trade in forest resources. Within a single Baka population, we showed that the in-situ walk-in-the-woods method resulted in more detailed information on wild food plant knowledge and use frequency than the ex-situ methods of freelisting and dietary recalls. Our in-situ method yielded 91 wild edible species, much more than the ex-situ freelisting interviews (38 spp.) and dietary recalls (12 spp.). Our results suggest that studies that are based only on ex-situ interviews may underestimate the importance of wild food plants for local communities. We discuss the limitations and strengths of these different methods for investigating the diversity of wild food plant knowledge and uses. Our analysis shows that future studies on wild food plants would profit from a mixed approach that combines in-situ and ex-situ methods.

[Comparison of Two Surgical Approaches for Osteosynthesis of Intraarticular Distal Humerus Fractures and Suggested New Treatment Algorithm for These Fractures]

PURPOSE OF THE STUDY The standard procedure in treating distal humerus fractures is the open reduction internal fixation (ORIF). The surgical approach is still a matter of discussion. The submitted study focuses on comparing the conventional approach with olecranon osteotomy and the paratricipital approach. MATERIAL AND METHODS Since January 2015 a total of 18 patients have been operated on, who met the inclusion criteria of the study on type C distal humerus fracture without the use of olecranon osteotomy. This group of patients was subsequently compared with a control group of patients in whom the olecranon osteotomy was performed in the period 2010-2015. The patients were assessed using the Mayo Elbow Performance Score (MEPS), the range of motion and complications, including the need for removal of osteosynthesis material. RESULTS The control group (Group 1), in which 22 patients operated directly by olecranon osteotomy were assessed, was compared with the group of operated patients (Group 2) consisting of 18 patients. When comparing the range of motion and MEPS, no significant difference was found between the groups (flexion: p = 0.519, extension: p = 0.382, MEPS: p = 0.110). Unlike Group 2, in Group 1 the osteosynthesis material of cerclage was removed in 13 cases. DISCUSSION Apart from the complexity of fracture and choice of fixation technique, it is the choice of surgical approach which constitutes another factor having effect on the final elbow function. Basically, the approaches to distal humerus can be divided into 4 groups, namely splitting, reflecting and sparing approaches and olecranon osteotomy which offers the best access to the fracture during fixation and which is recommended by many experts in treating these complex fractures which, however, has its disadvantages such as longer duration of surgery, longer healing time, non-union or malunion, protruding osteosynthesis material and secondary procedures necessary to remove the material. CONCLUSIONS In our study no significant difference in functional outcomes was found between the examined approaches. A difference was identified with respect to protruding material of the cerclage and soft tissue irritation with subsequent removal of osteosynthesis material after the olecranon osteotomy. Key words:distal humerus fracture, internal fixation, surgical approach, olecranon osteotomy, paratricipital approach, tricepssparing approach, triceps reflecting anconeus pedicle approach.

Guidelines and recommendations on yeast cell death nomenclature

Elucidating the biology of yeast in its full complexity has major implications for science, medicine and industry. One of the most critical processes determining yeast life and physiology is cel-lular demise. However, the investigation of yeast cell death is a relatively young field, and a widely accepted set of concepts and terms is still missing. Here, we propose unified criteria for the defi-nition of accidental, regulated, and programmed forms of cell death in yeast based on a series of morphological and biochemical criteria. Specifically, we provide consensus guidelines on the differ-ential definition of terms including apoptosis, regulated necrosis, and autophagic cell death, as we refer to additional cell death rou-tines that are relevant for the biology of (at least some species of) yeast. As this area of investigation advances rapidly, changes and extensions to this set of recommendations will be implemented in the years to come. Nonetheless, we strongly encourage the au-thors, reviewers and editors of scientific articles to adopt these collective standards in order to establish an accurate framework for yeast cell death research and, ultimately, to accelerate the pro-gress of this vibrant field of research.

Short and long-term results after endovascular management of vascular complications during transfemoral aortic valve implantation

Background Vascular injury and access site complications in the contemporary setting of transcatheter aortic valve implantation (TAVI) are known to be associated with increased mortality and morbidity. The aim of our study was to analyse the feasibility and safety of percutaneous treatment of such vascular complications using a stent graft. Methods Between January 2010 and April 2013, 36 TAVI patients developed severe access site complications and underwent subsequent interventional treatment with a covered stent. Acute treatment success was confirmed by angiography immediately after the implantation of the stent graft, with clinical long-term patency follow-up being assessed by duplex ultrasound. Results Of the 36 patients evaluated, percutaneous treatment of the acute access site bleeding was successful in 35 patients (97%), with one patient requiring surgical intervention due to insufficient haemostasis after stent graft implantation. A subset of 5 patients underwent successful ipsilateral stent graft implantation, either because crossover sheath placement was not feasible (n = 1), or intentionally with an even sheathless approach in an effort to reduce vessel injury (n = 4). After a mean follow-up of 22 ± 8 months, stent graft patency was confirmed by duplex ultrasound in 13 patients with an additional 5 patients reporting to be free from symptoms and claudication. Thirteen patients died within the first 24 months after the procedure, however, none was due to access vessel complications. Five patients were lost for follow-up. Conclusions Our data confirm that endovascular treatment of access site complications related to TAVI is feasible, safe and efficacious, resulting in long-term vascular patency.

[Conservative treatment of acetabular fractures: epidemiology and medium-term clinical and radiological results]

PURPOSE OF THE STUDY

The vast majority of studies on fractures of the acetabulum are concerned with surgical treatment. All displaced fractures are presented as surgically treated. The purpose of this study was to evaluate the results of surgical and conservative treatment of patients with acetabular fractures in relation to the degree of fracture displacement.

MATERIAL AND METHODS

We analysed 140 fractures of the acetabulum treated in our institution by different methods between 2009 and 2013. In addition to the use of Letournel´s classification, we allocated each fracture to one of six groups: 1. Sixty displaced fractures treated surgically, 2. Twenty three fractures with a displacement of more than 6 mm, 3. Eighteen slightly displaced fractures (2-3 mm in the acetabular roof or 4-5 mm in other parts of the acetabulum), 4. Twenty non-displaced fractures, 5. Six pelvic fractures involving the acetabulum and 6. Thirteen fractures of old people, mostly displaced but not examined by CT. Groups 2 to 6 were treated conservatively. In all patients, demographic and epidemiologic factors were analysed in relation to the patient's group assignment. In 107 patients, hip function was assessed using the Matta clinical grading system at a minimum follow-up of 12 months (average 3.16 years). Radiological status, time of admission, start of weight-bearing after the accident, working ability, mortality and complications were also evaluated.

RESULTS

Non-displaced fractures were often associated with serious injury or polytrauma in 20 patients; not all of them had excellent functional outcome. (mean score, 17.25). Excluding two patients who developed avascular necrosis, fourteen slightly displaced fractures had a fixal score of 16.92. Sixteen patients with displaced fractures were managed conservatively due to their poor medical condition and other circumstances. Their functional outcome (mean score, 15.25) was significantly worse than that of the patients with non-displaced fractures (p=0.02) and worse than the outcome in patients with slightly displaced fractures, but the difference was not significant (p=0.32). No occurrence of accelerated post-traumatic arthritis was observed in these groups. The mean clinical score of 14.80 and 60% of excellent and good results were achieved in surgically treated patients. Eight of them were treated by primary hip arthroplasty and osteosynthesis. A total of 11 patients required total hip arthroplasty because of post-traumatic osteoarthritis, but only one from the group of slightly displaced fractures, all others from the group of surgically treated patients.

DISCUSSION

Displaced fractures of the acetabulum are best treated by open reduction and internal fixation. The type of fracture and the quality of reduction influence the functional outcome. There are a few studies reporting long-term outcomes in conservatively treated acetabular fractures. Although conservative treatment continues to be the mainstay of treatment in most centres in the developing countries, it is obvious that not all of acetabular fractures can or must be treated surgically or identically. We found that, in many cases, surgery was too dangerous for the patient and his/her medical condition or that the result of surgery was doubtful, mostly because of a late presentation. In some cases, primary hip arthroplasty is a solution. Secondary total hip replacement is technically more demanding and has a higher rate of failure.

CONCLUSIONS

Conservative treatment is the method of choice for the treatment of non-displaced acetabular fractures. Excellent or very good results can also be expected in slightly displaced fractures if acetabular roof involvement is minor. In displaced fractures, if the result of surgery is doubtful under various circumstances or if high-risk medical conditions are present in the patient, conservative treatment can be the method of choice with satisfying results. Key words: acetabular fractures, conservative treatment, degree of displacement, epidemiology of acetabular fractures.

[Pedicle screw fixation of thoracic spine fractures]

PURPOSE OF THE STUDY

Fractures of the thoracic spine involve injury at the levels of Th2 to Th10. Because of pedicle morphology, pedicle screw fixation is a demanding procedure. However, evidence on the reliability and efficiency of this technique has recently been provided by several studies. The aim of this study was to analyse a group of patients with thoracic spine fractures treated by pedicle screw fixation and to evaluate treatment outcomes.

MATERIAL AND METHODS

A total number of 33 patients treated by pedicle screw fixation for thoracic spine fractures between January 2007 and December 2011 were enrolled in this retrospective study. The mean age was 39.7 ± 16.7 years. The evaluation included demographic data, mechanism of injury, associated injuries, neurological status, fracture type (AO classification), levels of the fractured vertebrae, injury-surgery interval, type and duration of surgery, type and length of pedicle screw fixation and complications. The position of pedicular screws in relation to the pedicle walls and correction of kyphotic deformity were assessed on post-operative CT scans.

RESULT

Of the 33 patients, 24 had associated injuries (72.7%), 22 had thorax injury (66.7%) and 17 had neurological deficit (51.5%). The most frequent spinal fracture type was type B2, 15 (45.5%); followed by type C, nine (33.3%); and type B1, five (15.1%). The mean injury-to-surgery interval was 5.2 ± 4.3 days. The mean operative time was 210 ± 56 min. The most frequently used configuration of pedicle screw fixation involving two segments above and two below the fracture level was used in 20 cases (58.8%). The position of 149 out of 282 pedicle screws (52.8%) was evaluated on post-operative CT scans as follows: 98 % of the pedicle screws were placed in acceptable positions, 76% were placed completely within pedicle borders. The mean pre-operative Cobb angle was 18.7° ± 8.2°, the mean post-operative Cobb angle was 9.3 ± 3.4°. Six intraoperative and three post-operative complications occurred. During follow-up no instrumentation failure or apparent loss of correction was recorded.

DISCUSSION

Early stabilisation of thoracic spine fractures reduces the risk of complications, shortens the hospital stay and allows for faster recovery of patients. Early thoracic spine stabilisation is most beneficial in patients with a high ISS (Injury Severity Score). In the case of small-sized pedicles there is the possibility of pedicle screw insertion via an extrapedicular or parapedicular trajectory. Recommended pedicle screw fixation is two levels above and two levels below the fracture level.

CONCLUSIONS

Pedicle screw fixation of thoracic spine fractures is a safe therapeutic method with a low risk of complications. It facilitates effective reduction and stable fixation with a low risk of secondary displacement and implant failure. Key words:transpedicular stabilisation, thoracic spine, fracture, pedicle screws.

Single-cell analysis of population context advances RNAi screening at multiple levels

A large set of high-content RNAi screens investigating mammalian virus infection and multiple cellular activities is analysed to reveal the impact of population context on phenotypic variability and to identify indirect RNAi effects.

Cell population context determines phenotypes in RNAi screens of multiple cellular activities (including virus infection, cell size regulation, endocytosis, and lipid homeostasis), which can be accounted for by a combination of novel image analysis and multivariate statistical methods.

Accounting for cell population context-mediated effects strongly changes the reproducibility and consistency of RNAi screens across cell lines as well as of siRNAs targeting the same gene.

Such analyses can identify the perturbed regulation of population context dependent cell-to-cell variability, a novel perturbation phenotype.

Overall, these methods advance the use of large-scale RNAi screening for a systems-level understanding of cellular processes.

Isogenic cells in culture show strong variability, which arises from dynamic adaptations to the microenvironment of individual cells. Here we study the influence of the cell population context, which determines a single cell's microenvironment, in image-based RNAi screens. We developed a comprehensive computational approach that employs Bayesian and multivariate methods at the single-cell level. We applied these methods to 45 RNA interference screens of various sizes, including 7 druggable genome and 2 genome-wide screens, analysing 17 different mammalian virus infections and four related cell physiological processes. Analysing cell-based screens at this depth reveals widespread RNAi-induced changes in the population context of individual cells leading to indirect RNAi effects, as well as perturbations of cell-to-cell variability regulators. We find that accounting for indirect effects improves the consistency between siRNAs targeted against the same gene, and between replicate RNAi screens performed in different cell lines, in different labs, and with different siRNA libraries. In an era where large-scale RNAi screens are increasingly performed to reach a systems-level understanding of cellular processes, we show that this is often improved by analyses that account for and incorporate the single-cell microenvironment.

BAP31 and BiP are essential for dislocation of SV40 from the endoplasmic reticulum to the cytosol

How non-enveloped viruses overcome host cell membranes is poorly understood. Here, we show that after endocytosis and transport to the endoplasmic reticulum (ER), but before crossing the ER membrane to the cytosol, incoming simian virus 40 particles are structurally remodelled leading to exposure of the amino-terminal sequence of the minor viral protein VP2. These hydrophobic sequences anchor the virus to membranes. A negatively charged residue, Glu 17, in the α-helical, membrane-embedded peptide is essential for infection, most likely by introducing an 'irregularity' recognized by the ER-associated degradation (ERAD) system for membrane proteins. Using a siRNA-mediated screen, the lumenal chaperone BiP and the ER-membrane protein BAP31 (both involved in ERAD) were identified as being essential for infection. They co-localized with the virus in discrete foci and promoted its ER-to-cytosol dislocation. Virus-like particles devoid of VP2 failed to cross the membrane. The results demonstrated that ERAD-factors assist virus transport across the ER membrane.

[Atypical tonic pupil as a complication of chickenpox infection]

BACKGROUND

Pupillary disorders following varicella infections are rare and few cases have been reported which were only partially pharmacologically tested.

MATERIALS AND METHODS

A 5-year-old boy presented with a left-sided dilated and unreactive pupil, 3 months before he had suffered from chickenpox and in the course of the acute disease developed anterior uveitis which was treated with local prednisone and mydriatics. The pupil remained dilated despite discontinued medication, light reaction was absent and accommodation was impaired. Pilocarpine supersensitivity was an indication against a lesion of the sphincter muscle and reduced response to cholinesterase inhibitors (physostigmine) pointed towards a postganglionic lesion.

CONCLUSIONS

It is probable that a varicella virus infection of the short ciliary nerves and the ciliary ganglion caused anterior uveitis and a postganglionic parasympathetic nerve lesion, clinically presenting as a tonic pupil. According to cases previously reported an irreversible nerve lesion has to be assumed.

[Clinical features and treatment of cutaneous carcinoid]

An exemplary case of a 67-year-old patient with multiple cutaneous metastases of a pulmonary carcinoid primary tumor is presented. The cardinal symptom was severe painfulness of the skin tumors. With chemotherapy the tumor disease advanced. In presenting this case and providing a review of the literature, the primary importance of surgery even in the case of a metastasizing carcinoid is emphasized.